What is an example of a GP modifier?
Asked by: Arno Yundt | Last update: August 8, 2025Score: 4.6/5 (9 votes)
When should a GP modifier be used?
Use a GP modifier in any case where there could be confusion as to which provider delivered services to a patient, such as in any interdisciplinary therapy setting.
What insurances require a GP modifier?
These plans include Blue Cross Blue Shield of Michigan, Blue Cross of California (Note: This does not include Blue Shield of California), BCBS plans of Indiana, Kentucky, Missouri, New Jersey, New York (Empire), Ohio, Vermont, and Wisconsin. (*Note: If it is an Anthem policy there will also be a need for modifier GP.
What is an example of a CPT code with a modifier?
CPT® code 71046 Radiologic examination, chest; 2 views is an example of a code that has both professional and technical components. Using modifier 26 Professional component allows the provider to claim reimbursement for the provider's work, including supervision, interpretations, and reports.
What is the difference between go and GP modifier?
Modifier GN – Services delivered under an outpatient speech therapy plan of care. Modifier GO – Services delivered under an outpatient occupational therapy plan of care. Modifier GP – Services delivered under an outpatient physical therapy plan of care.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
Does 97140 need a GP modifier?
Here are some common modifiers used with 97140 and when to apply them: Always Therapy Modifiers: GP: This modifier indicates that the services were provided by a physical therapist. It's required for Medicare claims and often used by other payers as well.
What modifier is used for telehealth visits?
Per the AMA, modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” It's similar to GT in use cases, but unlike GT there are limits to the codes that it can be appended.
How do you know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What modifier is used with 97110?
Modifiers GP(Outpatient Physical Therapy), GO (Outpatient Occupational Therapy), GN (Outpatient Speech-Language Pathology), CO (Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)), CQ (Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)), ...
What are the most used modifiers in medical billing?
Understanding commonly used modifiers in medical billing is crucial for accurate reimbursement and avoiding claim denials. Modifiers such as 22, 25, 26, 33, 50, 51, and 59 play a significant role in communicating additional information about the services provided.
Can a chiropractor use GP modifier?
So if you render and bill for 1-2 regions of CMT (98940) and therapeutic exercise (97110), then the 97110 chiropractic CPT code will receive the GP modifier.
Does UnitedHealthcare require GP modifier?
Effective with dates of service on or after July 1, 2020, UnitedHealthcare aligns with CMS and requires HCPCS modifiers GN, GO or GP to be reported with the codes designated by CMS as always therapy services.
What is modifier GP 59?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services. FACT SHEET.
Who can bill with a GP modifier?
Used in conjunction with CPT® (Current Procedural Terminology) codes, the modifier “GP” shows that the therapy services were specifically provided by a physical therapist. This helps ensure accurate billing and reimbursement for physical therapy services under Medicare and other insurance company plans.
What insurance companies require the GP modifier?
The use of the GP modifier is required now on all claims to United Health Care and their affiliates, VA claims, Medicare claims, Blue Cross Blue Shield of Michigan and now Anthem Blue Cross of California.
How do you know if a CPT code needs a modifier?
- A service or procedure has both a professional and technical component, but only one component is applicable.
- A service or procedure was performed by more than one physician or in more than one location.
When to add GP modifier?
Every service performed by a physical therapist (PT), occupational therapist (OT), or speech-language pathologist (SLP) requires a therapy modifier (GP, GO, GN) for claim submission. So in this scenario, you would affix the GP modifier to the claim.
What modifiers can be used with 99214?
Modifiers can be used with 99214 if applicable. For example, you can add Modifier 25 to the E/M visit with 99214 if there was a “separately identifiable E/M on the same day of a procedure” (source: ACC). Or add modifier 22 if the procedure was extra complex.
What modifier should be used with 90834?
In behavioral health, the modifier 95 is added to the original code to signify teletherapy. For example, you would add the 95 modifier to 90834 to signify a 45-minute teletherapy session (i.e., 90834-95). To be billed with this modifier, a face-to-face video session needs to have occurred.
What is the best modifier?
The best universal modifier is Godly or Demonic. The two modifiers only differ in knockback, a stat that is not considered very useful (or even beneficial) in many situations. The difference in knockback is also negligible enough that Godly and Demonic can be treated as the same modifier.
Which modifier goes first?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first. There's a straightforward reason to this, too.
How do you use modifiers correctly?
- Always place modifiers as close as possible to the words they modify. ...
- A modifier at the beginning of the sentence must modify the subject of the sentence. ...
- Your modifier must modify a word or phrase that is included in your sentence.
What is the GN GO or GP modifier?
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech-language pathology services. They should never be used with codes that are not on the list of applicable therapy services.
Do you use 95 or GT modifier for telehealth?
The GT modifier is actually becoming less and less common and has been replaced by either modifier 95 or the place of service code 02. Some private insurance companies still recognize and accept the GT modifier for telehealth services.
What is a POS 11 in medical billing?
POS 11 points towards a doctor's office, clinic or practice. When you visit a doctor's office or clinic, they will include PSO 11 in the medical bill to show the exact location of care provided.